Just remembering the schedule for every activity, social or business,
can become overwhelming, so who has time to keep track of her period?
If you are wondering whether or not your period is normal, below is a
diary to help you keep track of your monthly cycle.

Need
Treatment for Heavy Bleeding?

Find a physician who performs endometrial
ablation using the HTA® system to treat heavy menstrual bleeding.
Find a physician near
you.

This
tool can also be useful to show your doctor to discuss any questions
or concerns you might have. Print this form out every month or print
multiple copies now, answer the questions after your period and compare
to other months.

Automatically select a date
by clicking on the calendar icon.

What was
the start date of your period this month?

What was
the end date of your period this month?

How many tampons/pads were fully saturated each day of your
period?

Day
1:

Day
2:

Day
3:

Day
4:

Day
5:

Day
6:

Day
7:

Day
8:

Day
9

Day
10:

Day
11:

Day
12:

Day
13:

Day
14:

Day
15:

Did you miss any days of work because of your period this month?YesNoIf you answered Yes, how many days did you miss?Date(s):

Did you miss any social activities because of your period this
month?
Yes
No

Which ones? (Select dates.)

Event

Date

Did you feel especially weak or fatigued during your period
this month?
Yes
No

Date(s):

Symptoms:

Did your period disrupt your sexual activity because it was
so heavy this month?
Yes
No

Disclaimer:
The information provided within this website is for educational purposes
only and is not a substitute for consultation with your physician or healthcare
provider. The opinions expressed herein are not necessarily those of the
Owners and Sponsors of this site. By using this site you agree to indemnify,
and hold the Owners and Sponsors harmless, from any disputes arising from
content posted here-in.